Investigating frank autism: clinician initial impressions and autism characteristics.

The sample was small, demographically homogeneous, and included only speaking autistic participants, so results may not apply to nonspeaking autistic people or more diverse groups. There were more females in the neurotypical group than in the autism or LAD groups, and the study was underpowered to test gender differences or which behaviors led to rater disagreement. The five-minute clips came from a clinical research setting and varied in content, including some structured ADOS-2 activity and some informal setup, so findings may not generalize to casual observations. Online and in-person administrations began with different ADOS-2 activities, although accuracy and total scores did not differ by modality. Raters were graduate and expert clinicians with autism-specific training, so the findings may not apply to clinicians without autism-specific training. Item-level inter-rater reliability was not assessed because expected variability in which behaviors contributed to impressions. Participants were selected to have normal-range cognition and adaptive behavior and no severe psychiatric disorders, limiting generalizability to more complex presentations.

The study was funded by the National Institute of Mental Health and the National Institute on Deafness and Other Communication Disorders. The supplied text lists no other conflicts of interest.

Do not use a five-minute impression alone to rule out autism. The authors report that trained clinicians did not have an initial impression of autism for roughly 33% of autistic individuals, and they state that brief observations alone are not sufficient to detect all cases.